New Options for Simple, Quick Enrollment in Medicaid and CHIP

By Vikki Wachino

Medicaid continues to make advances in covering and enrolling eligible low-income people in health insurance coverage.  Our latest data, released today, show that as of June, enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) grew by almost 13.1 million people since just before the first Marketplace open enrollment period in 2013.  And Medicaid and CHIP enrollment increased by more than 292,000 individuals since May. Simplified policies and systems advances that promote timely enrollment of eligible people in coverage underpin this progress.  Today, CMS is taking the next step in those efforts by making new opportunities available for states to help enroll people in Medicaid and CHIP quickly and easily.  Under new guidance released today, we are offering states an opportunity to use Supplemental Nutrition Assistance Program (SNAP) data to support Medicaid eligibility determinations for some people who are certain to be Medicaid eligible at both initial application and renewal.  Under new guidance released today (http://www.medicaid.gov/federal-policy-guidance/downloads/sho-15-001.pdf), we are offering states a new state plan option to use gross income established in Supplemental Nutrition Assistance Program (SNAP) to support Medicaid eligibility determinations for some people who are certain to be Medicaid-eligible at both initial application and renewal.  The new guidance also clarifies and extends the time frame that applies in states that are using or wish to take up targeted enrollment strategies under the waiver authority we established in 2013. The new state plan option builds on targeted enrollment strategies CMS established under waiver authority in 2013 for states to enroll or renew eligibility without requiring individuals to complete a new application or renewal form.  Those strategies, which six states have used to enroll more than 725,000 people, have been used to successfully and efficiently enroll individuals newly eligible for Medicaid coverage and helped states promote rapid enrollment, manage high application volumes, and manage systems constraints.  Tomorrow, as Alaska becomes the 30th state (including DC) to implement Medicaid expansion, it will use some of those strategies to help low-income adults enroll quickly so that they can get needed care. By connecting newly enrolled adults with health care, Medicaid is helping them identify and address health needs and promote their health and well-being. We have been pleased to work with our partners at USDA’s Food and Nutrition Service in strengthening the connection between SNAP and Medicaid so that more low-income families and individuals will have both the nutritional support and the health care they need to build financial security and health.  We welcome additional ideas as we continue to work with states on expanding Medicaid and on simplifying and streamlining enrollment of eligible people in Medicaid and CHIP.  

New Medicaid initiative improves access to substance use disorder treatment

Byline: Vikki Wachino

The Medicaid program plays an important role in providing access to treatment for individuals with a substance use disorder (SUD). Nearly 21 million Americans suffer from SUD, many of whom are low-income or uninsured. It is estimated that 12 percent of all Medicaid beneficiaries ages 18-64 and 15 percent of uninsured individuals who could be eligible for Medicaid coverage have SUD. Medicaid pays one out of every five dollars for SUD treatment.

As states identify new ways to promote stronger systems of care that improve access to affordable quality health care, strengthening approaches to SUD services is a major area of focus. Many states are seeking to reform SUD treatment services in a way that meets the needs of individuals as well as the capacity for treatment in their states.

The Centers for Medicare & Medicaid Services (CMS) is working with states to develop system reforms that improve care, enhance treatment, and offer recovery supports for individuals with SUD. For the past year, CMS has worked with states through our new Medicaid Innovation Accelerator Program to provide program support for states to pursue innovations that reduce costs and improve health outcomes for beneficiaries with SUD. We have also been in active dialogue with states on ways to combat the opioid and heroin epidemic that is ravaging many rural and urban communities alike.

Building upon this effort, CMS is now launching a new demonstration initiative to support comprehensive, evidence based service delivery approaches to SUD treatment. This initiative is available to states seeking to undertake significant improvements in the delivery of care to beneficiaries with SUD, such as better identifying individuals with SUD, increasing treatment provider capacity, using evidence-based practice standards, and measuring progress with quality metrics.

The initiative provides greater flexibility for states that undertake significant reforms to provide coverage for short-term inpatient and residential SUD services – services generally not covered by Medicaid. These improvements will help states develop effective care coordination models that better connect those with SUD to providers, provide more integrated health care services to beneficiaries with SUD, and effectively integrate SUD treatment with community-based care.  

We recognize the importance of effective SUD treatment and remain committed to working with states and stakeholders to improve SUD services for millions of individuals.

For more information on the demonstration initiative, visit http://www.medicaid.gov/federal-policy-guidance/downloads/SMD15003.pdf.

Continuing to work with states to build new systems of health coverage

By Cindy Mann CMS Deputy Administrator and Director, Center for Medicaid and CHIP Services

CMS is committed to working in partnership with states in administering their Medicaid and Children’s Health Insurance Programs (CHIP) and to providing flexibility in pursuit of our shared goals.

Premium assistance has been a longstanding option in both Medicaid and CHIP and is one way to accomplish those shared goals.  CMS provided guidance in December of last year on how states might use these options to develop state-based solutions that meet both the state’s unique needs and requirements of the programs

In response to some questions that have been raised by states, today we are issuing some clarifying guidance.   Today’s Frequently Asked Questions explain the basic requirements that apply when a state chooses the premium assistance option and the guidelines we would apply when a state requests a waiver to implement premium assistance.  Under both approaches, individuals remain Medicaid beneficiaries and continue to be eligible for benefits and cost-sharing protections established by law.

As we review waiver proposals, HHS will consider factors that will impact cost effectiveness, such as those introduced by the creation of Health Insurance Marketplaces.

We remain committed to working with states and providing them with the flexibility and resources they need to build new systems of health coverage.  Premium assistance is simply one option, and we will continue to work with states on solutions that work best to meet shared goals.  We encourage states to come to us with their delivery system ideas, and look forward to continuing to work with states on these and other innovative approaches.

Premium Assistance FAQ

CMS Online Information Just Got Better

By Julie Green Bataille, Director, Office of Communications

We’re always looking for ways to make your experience with the Medicare, Medicaid, Children’s Health Insurance, and other health care programs better. Today, we’re expanding and enhancing our online presence at the Centers for Medicare & Medicaid Services (CMS): we’re debuting a new look and feel for CMS.gov, and launching a brand-new site for the Medicaid program, Medicaid.gov.

These changes reflect what we’ve heard from you – our users – and respond to what you’ve said you want to be able to do on our site.  Here’s what you’ll find on the new CMS and Medicaid sites:

  • A significantly improved search engine that gets you to the information you’re looking for, fast.
  • More in-depth information about what we’re doing to implement the Affordable Care Act and other new initiatives, and details about how you can apply for new programs.
  • Up-to-date, real-time updates that reflect important developments and initiatives happening with CMS programs.
  • Medicaid program information that’s readily available, easy to find, and easy to use— and we’ll be continually looking for ways to enhance your experience on this site.
  • Easy-to-access links to Healthcare.gov, which will continue to be the primary site for consumer information.

While we’ve moved content around to make it easier to find, don’t worry that you’ll lose access to any of the current Medicare and Medicaid information you rely on now. We’re launching an archive version of each of our websites too, so that historic information can remain online without adding clutter to our primary sites.

We think these changes are a good first step to improving our online presence and making information more accessible for all the patients, partners, providers, States, advocates and others who interact with our programs. However, this is just the first step — we have plans for continuous, ongoing improvements.

Take a look around at our www.cms.gov and www.Medicaid.gov, and let us know what you think. We’d like to use your feedback to help drive the direction of future website improvements.

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